Re-irradiation or re-operation followed by dendritic cell vaccination? Comparison of two different salvage strategies for relapsed high-grade gliomas by means of a new prognostic model

Abstract

We aimed to compare two different salvage treatment strategies for relapsed high-grade glioma (HGG) patients by means of a new prognostic model. A simplified version of the so-called HGG-Immuno RPA model estimates the prognosis of relapsed HGG patients and distinguishes three different prognostic classes (I = good, II = intermediate, III = poor). The model has been constructed with a cohort of 117 patients whose salvage treatment consisted of re-operation followed by dendritic cell vaccination (ReOP ? DCV). However, using only the predictors histology, age and performance status, the simplified HGG-Immuno RPA model is basically independent from treatment. In the present study we applied the simplified model to the cohort used to construct the original HGG-Immuno RPA model and another cohort of 165 patients who underwent re-irradiation (ReRT) at relapse. Then, we compared the outcomes achieved by the two different salvage treatments in each prognostic class. The model predicted good, intermediate and poor prognosis for 11, 31 and 75 patients of the ReOP ? DCV cohort and for 20, 39 and 106 patients of the ReRT cohort, respectively. Neither of the two strategies was superior to the other. In the groups with good, intermediate and poor prognosis 12-months survival rates were 73, 59 and 25 % after ReOP ? DCV and 72, 36 and 23 % after ReRT, respectively. Being easy to handle and independent from treatment, the aforementioned model is useful for therapeutic decisions. ReRT and ReOP ? DVC seem to be equally effective. The choice of salvage treatment should be based on the expected side effects.

Efficacy and safety analysis on dendritic cell-based vaccine-treated high-grade glioma patients: a systematic review and meta-analysis

“…Of these, 25 studies were excluded because they were not appropriately controlled, and four other studies were excluded due to absence of data for analysis. Eventually, three RCTs 18 – 20 and ten NRS, including five non-randomized controlled trials, 21 – 25 four historically controlled studies, 26 – 29 and one cohort study, 30 involving 307 DC-vaccinated (DC group) and 637 non-DC-vaccinated (CT group: control therapy group) patients, were included in the meta-analysis. The detailed selection process was described in Figure 1 , according to the PRISMA Statement for reviews and meta-analysis.…”

“…All studies enrolled patients with HGGs of grade III anaplastic astrocytomas (AA), and/or IV (GBM). One cohort study, 30 two pilot studies, 21 , 26 four Phase I trials, 22 , 25 , 27 , 29 three Phase II trials, 18 – 20 and three Phase I/II trials were included in these studies. 23 , 24 , 28 Most of the studies enrolled patients with Karnofsky performance scale (KPS) score of ≥60, 20 , 22 , 23 , 25 , 27 two studies with KPS score of ≥70, 19 , 28 and only one study with KPS score of ≥80.…”

“… 29 However, there were still five studies without inclusion criteria for KPS score or relative data not available. 18 , 21 , 24 , 26 , 30 All studies contained at least two arms, one arm was conventional treatment, such as surgery, radiation, and TMZ chemotherapy, while the other arm had the addition of DC vaccination. For 7/13 studies, surgery, radiation, and chemotherapy were applied in both arms.18–20,22,24,26,27,29 Surgery and radiation were applied in two studies.…”

Re-irradiation for Recurrent Primary Brain Tumors

“…Other data suggest that no significant difference between re-irradiation and surgery exists (19). In this study, both local approaches were followed by dendritic cell vaccination.…”

“…Müller et al defined three prognostic classes based on histology, age and performance status (19). Regardless of local treatment approach (re-irradiation or surgery, each followed by dendritic cell vaccination), the 1-year survival rate was approximately 70% in the best prognostic group.…”